Peer-reviewed article
Socio-economic determinants for reduced uptake of routine childhood vaccination in Afghanistan.
Sayed Ataullah Saeedzai, Jo Knight, Luis Filipe, Sam Moore, Benjamin Loevinsohn ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzes data from Afghanistan's 2022-23 Multiple Indicator Cluster Survey to identify why childhood vaccination rates are low and falling. Researchers examined 6,178 children aged 12-23 months and found that vaccination coverage varies significantly by household language, maternal education, and wealth. Children from Pashto-speaking households, with uneducated mothers, or from poorer families were much less likely to be fully vaccinated. The findings suggest that improving maternal education and healthcare access could help increase immunization rates.
Key points
- Only 33% of Afghan children aged 12-23 months received complete vaccination schedules
- Pentavalent vaccine coverage fell from 60% (2013-18) to 51% (2022-23)
- Children from Pashto-speaking households had 3.5 times higher odds of being unvaccinated than fully vaccinated
- Children whose mothers had no formal education had a 69.1% rate of being unvaccinated or under-vaccinated compared to 41.9% for those with primary education
- Children from the richest households had 55.9% full vaccination coverage and were 78% less likely to be unvaccinated
Limitations
This is a cross-sectional analysis and cannot establish causality between socio-demographic factors and vaccination decisions. The study does not explore the specific mechanisms or barriers behind the associations observed, such as vaccine availability, access barriers, or caregiver beliefs.
Abstract
BACKGROUND: Coverage of many routine childhood vaccinations in Afghanistan is low and declining. For instance, only 60% of eligible children received doses of the pentavalent vaccine in 2013-18, and this fell to 51% in 2022/23. OBJECTIVE: To help explain the underlying causes behind this trend, this study aims to identify socio-demographic factors relating to caregivers whose children are either entirely unvaccinated or only partially vaccinated. METHOD: A secondary analysis of Multi Indictor Cluster survey (MICS) 2022/23 data was conducted that focused on the level of vaccination children had received by the time they reach their first birthday. Children were categorized into unvaccinated, under-vaccinated, and fully vaccinated groups and binary and multinomial logistic regression models were fitted with household characteristics included as explanatory variables. RESULTS: The study data comprised 6,178 children aged 12-23 months with a predominance of rural areas (76.2%). In the multinomial analysis, children from Pashto-speaking households had significantly higher odds of being unvaccinated (OR = 3.54, 95% CI: 2.62-4.79) and under-vaccinated (OR = 2.19, 95% CI: 1.74-2.75) compared with those who were fully vaccinated. Maternal education was found to be highly significant, with children whose mothers had no formal education found to be more likely to be under vaccinated (69.1% unvaccinated/under-vaccinated) compared to those with primary education (41.9% unvaccinated/under-vaccinated, adjusted odds ratio: 0.59. 95% CI: 0.43-0.81). Children from the richest households had a full vaccination rate of 55.9% and were less likely to be unvaccinated than fully vaccinated (adjusted odds ratio: 0.22, 95% CI: 0.14-0.35). CONCLUSION: Full vaccination coverage is low, with approximately one-third of Afghan children aged 12-23 months receiving complete vaccine schedules. However, this study shows that rates vary significantly with a range of cultural, economic, and educational factors. These findings suggest that improving maternal healthcare access and education, along with focused outreach in specific demographic groups, may be effective in enhancing immunization coverage.